• Gonzalo Hernández Martínez, Maria-Luisa Rodriguez, Maria-Concepción Vaquero, Ramón Ortiz, Joan-Ramon Masclans, Oriol Roca, Laura Colinas, Raul de Pablo, Maria-Del-Carmen Espinosa, Marina Garcia-de-Acilu, Cristina Climent, and Rafael Cuena-Boy.
• From Virgen de la Salud University Hospital (G.H.M., M.-L.R., L.C.) and the Research Unit, Medical Council (R.C.-B.), Toledo, Ramón y Cajal University Hospital (M.-C.V., R.P.) and Ciber Enfermedades Respiratorias, Health Institute Carlos III (O.R.), Madrid, Ciudad Real University Hospital and Ciudad Real University, Ciudad Real (R.O., M.-C.E.), Medical Research Mar Institute (J.-R.M.), the Critical Care Department, Autònoma de Barcelona University (J.-R.M., M.G.-A.), Del Mar University Hospital (J.-R.M., C.C.), Vall d'Hebron Research Institute (O.R.), and Vall d'Hebron University Hospital (O.R., M.G.A.), Barcelona, and Alcala University, Alcalá de Henares (R.P.) - all in Spain.
• N. Engl. J. Med. 2020 Sep 10; 383 (11): 1009-1017.

BackgroundWhen patients with a tracheostomy tube reach a stage in their care at which decannulation appears to be possible, it is common practice to cap the tracheostomy tube for 24 hours to see whether they can breathe on their own. Whether this approach to establishing patient readiness for decannulation leads to better outcomes than one based on the frequency of airway suctioning is unclear.MethodsIn five intensive care units (ICUs), we enrolled conscious, critically ill adults who had a tracheostomy tube; patients were eligible after weaning from mechanical ventilation. In this unblinded trial, patients were randomly assigned either to undergo a 24-hour capping trial plus intermittent high-flow oxygen therapy (control group) or to receive continuous high-flow oxygen therapy with frequency of suctioning being the indicator of readiness for decannulation (intervention group). The primary outcome was the time to decannulation, compared by means of the log-rank test. Secondary outcomes included decannulation failure, weaning failure, respiratory infections, sepsis, multiorgan failure, durations of stay in the ICU and hospital, and deaths in the ICU and hospital.ResultsThe trial included 330 patients; the mean (±SD) age of the patients was 58.3±15.1 years, and 68.2% of the patients were men. A total of 161 patients were assigned to the control group and 169 to the intervention group. The time to decannulation was shorter in the intervention group than in the control group (median, 6 days [interquartile range, 5 to 7] vs. 13 days [interquartile range, 11 to 14]; absolute difference, 7 days [95% confidence interval, 5 to 9]). The incidence of pneumonia and tracheobronchitis was lower, and the duration of stay in the hospital shorter, in the intervention group than in the control group. Other secondary outcomes were similar in the two groups.ConclusionsBasing the decision to decannulate on suctioning frequency plus continuous high-flow oxygen therapy rather than on 24-hour capping trials plus intermittent high-flow oxygen therapy reduced the time to decannulation, with no evidence of a between-group difference in the incidence of decannulation failure. (REDECAP ClinicalTrials.gov number, NCT02512744.).Copyright © 2020 Massachusetts Medical Society.

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